Loneliness and depression among older adults with cancer: an exploratory analysis of psychosocial constructs

Addison Kitrel, Ellen Park, Elizabeth Schofield, Caraline Demirjian, Nisha Mehta, Erica Fortune, Christian Nelson, Rebecca Saracino

Introduction Loneliness is a common and clinically significant concern among older adults with cancer (OACs; age ≥70), who often experience heightened psychological distress compounded by aging-related challenges. The current study sought to identify the nature and magnitude of the relationships between loneliness and other psychosocial variables. Methods Data were drawn from the baseline assessment of an ongoing randomized controlled trial of psychotherapy for distressed OACs. Loneliness was assessed using the PROMIS Social Isolation measure. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale–Depression subscale and the Center for Epidemiologic Studies Depression Scale. Psychosocial factors included attitudes toward aging, demoralization, and anxiety. Fully adjusted regression models were conducted to examine the independent associations of loneliness and psychosocial factors with depressive symptoms while accounting for demographic covariates. Results Among 258 participants, social isolation was positively associated with depressive symptoms at the bivariate level (CES-D: r =.694; p <.001; HADS-D: r =.629, p <.001). In fully adjusted models, social isolation (p <.001), anxiety (p = 0.015), and demoralization (p = 0.001) were independently associated with depressive symptoms. Discussion Findings suggest that loneliness is independently associated with depressive symptoms among distressed OACs, even when accounting for other psychosocial variables and demographic characteristics. Anxiety and demoralization showed stronger and more consistent associations with depressive symptoms than attitudes toward aging. Although causal direction cannot be inferred from cross-sectional data, results highlight potential psychosocial targets for intervention and underscore the need for longitudinal research to clarify the dynamic relationships among loneliness, psychosocial factors, and depression in OACs.